Traumatic brain injury (TBI) disproportionately affects low- and middle-income countries (LMICs). In these settings, accurate patient prognostication is both difficult and essential for high-quality patient care. With the ultimate goal of enhancing TBI triage in LMICs, we aim to develop the first deep learning model to predict outcomes after TBI and compare its performance to that of less complex algorithms.
TBI patients’ data were prospectively collected in Kampala, Uganda, from 2016 to 2020. To predict good versus poor outcome at hospital discharge, we created deep neural network (DNN), shallow neural network (SNN), and elastic-net regularized logistic regression (LRnet) models. Predictors included 13 easily acquirable clinical variables. We assessed model performance with 5-fold cross-validation to calculate areas under both the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC), in addition to standardized partial AUPRC (spAUPRC) to focus on comparisons at clinically-relevant operating points.
We included 2164 patients for model training, of which 12% had poor outcomes. The DNN performed best as measured by AUROC (0.941) and spAUPRC in region maximizing recall (0.291), whereas the SNN was best by AUPRC (0.770). In several other comparisons, the LRnet was non-inferior to the neural networks.
We present the first use of deep learning for TBI prognostication, with an emphasis on LMICs, where there is great need for decision support to allocate limited resources. Optimal algorithm selection depends on the specific clinical setting; deep learning is not a panacea, though it may have a role in these efforts.

Copyright © 2022. Published by Elsevier Inc.

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